Why cardiologists are calling Lipoprotein(a) the next big heart health marker

When it comes to heart health, most of us already know the drill: keep an eye on cholesterol, watch your blood pressure, and maybe get your blood sugar checked. But there’s a new player that cardiologists are buzzing about: Lipoprotein(a), or Lp(a) for short.

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If you’ve never heard of it, you’re not alone. For years, Lp(a) flew under the radar, even though researchers have known about it for decades. Now, more doctors in the US, UK, Canada and other places where heart disease is a major health concern, are saying it could be one of the most important heart health markers of our time.

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Think of Lp(a) as cholesterol’s sneaky cousin. It’s a type of lipoprotein, basically a particle that carries cholesterol and fats through your blood. The “(a)” part is a sticky little protein that makes it more dangerous than regular LDL (the so-called “bad” cholesterol).
Why dangerous? Because Lp(a) doesn’t just float around, it clings to artery walls and fuels plaque buildup. Over time, this can make your arteries narrow and stiff, setting the stage for heart disease, strokes, and other cardiovascular problems.

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In fact, about 20–25% of people in North America and Europe have elevated Lp(a) levels. That’s millions of people walking around with a hidden risk factor they’ve never been tested for.

For years, most doctors didn’t routinely test for Lp(a). The focus was on LDL, HDL (the “good” cholesterol), and triglycerides. But new research shows that high Lp(a) levels can independently raise your risk of heart attack and stroke, even if all your other numbers look fine.
That means someone with “normal” cholesterol might still be at risk, and they’d never know it unless they got tested for Lp(a). No wonder cardiologists are calling it the “next big marker” in heart health.

Dr. Gajinder Kumar Goyal, Program Clinical Director - Cardiology, Marengo Asia Hospitals Faridabad, we are paying more attention to Lipoprotein(a), our next major marker in our ability to care for the heart. Unlike LDL, cholesterol which most people are aware of, Lp(a) is a genetic form of cholesterol that is mainly not impacted by our lifestyle or diet. Lp(a) is carried within us in blood and can cause plaque formation in the arteries, which increases the likelihood of heart attack, stroke, and aortic valve disease. What is especially problematic in relation to Lp(a), is that - in many cases of elevated Lp(a) people are otherwise healthy with normal cholesterol readings but they still have unknown heart disease risk factors associated with cardiovascular risks.
Research indicates that a maximum of approximately 20-25% of the overall population may have elevated Lp(a) levels. There are no specific medications currently widely approved to treat it. There are some promising medications in development. For now, we emphasize the importance of testing, and testing for Lp(a) is not routinely done in the regular check-ups we go through. A simple blood test can determine your Lp(a) levels, allowing you to determine some individuals at risk for it, sooner.
With increasing rates of heart disease, Lp(a) could potentially take its place as an important marker for cardiovascular risk, and by recognizing and treating it early, we will be able to prevent heart disease cases with individuals that would otherwise fall through the cracks of standard cholesterol testing.

Dr. Anand Kumar Pandey, Senior Director - Cardiology, Max Super Speciality Hospital, Vaishali says, in relation to cardiovascular health Lp(a), is gaining traction as a next-generation biomarker, and many cardiologists want people to focus on it. Lp(a) has a structure that is similar to that of LDL or bad cholesterol but it has one extra protein, apolipoprotein(a), that we believe is responsible for its more deleterious effects on arteries. Lp(a) behaves differently from traditional cholesterol because its levels are largely determined by genetics and remain relatively stable throughout life. In other words, lifestyle changes such as dietary modification and exercise do little to change Lp(a) levels. Elevated Lp(a) levels are associated with an increased risk of heart attacks, and strokes and aortic valve narrowing, even among individuals who have normal cholesterol and blood pressure levels. As such, while Lp(a) is a critical, underappreciated cardiovascular risk factor, few health care professionals routinely measure it.

Roughly one in three individuals may have elevated Lp(a), yet it is currently not part of routine cholesterol screening, Dr Anand adds. Because Lp(a) is not assessed routinely, many people may be unaware of their elevated Lp(a). For those with a family history of premature heart disease or who have suffered unexplained cardiac events, testing for Lp(a) can provide valuable information. At this time, no validated therapies to directly lower Lp(a) exist, but clinical trials are currently investigating advanced modalities such as antisense drugs and siRNA therapies. Statins, while extensively used as the clinical gold standard to lower LDL, have little-to-no impact on lowering Lp(a). Because it has the potential to explain “hidden risk” in patients, and with its relationship to heart disease as a likely explaining factor, cardiologists have been vocal about the need for more routine testing and research into Lp(a), keeping it a promising and exciting new frontier in the prevention and management of heart disease.

Yes, and the good news is it’s a simple blood test. The bad news? Not all doctors automatically include it in standard checkups.
Some experts recommend that everyone should get tested at least once in their lifetime, especially if:
You have a family history of early heart disease (heart attacks or strokes before age 60).
You’ve had heart problems even though your cholesterol is “normal.”
You’re from certain ethnic groups (people of African descent tend to have higher Lp(a) levels).

Here’s where things get tricky. Unlike regular cholesterol, lifestyle changes don’t really move the needle much. Eating better, exercising, and not smoking are still essential for heart health, but they won’t directly lower Lp(a).
In the meantime, if you find out your Lp(a) is high, doctors usually focus on lowering other risks. That might mean:
Keeping LDL cholesterol as low as possible.
Controlling blood pressure and blood sugar.
Using statins or other medications if needed.
Adopting heart-healthy habits (Mediterranean-style diet, regular activity, stress management).